CMS Issues Final Administrative Simplification Final Rules Regarding Identifiers and ICD-10 Code Set Compliance Delay

August 24, 2012.  Today, the Office of Management and Budget (OMB) completed review and sent to the Federal Register for publication on September 5, 2012, the Centers for Medicare & Medicaid Services (CMS) Final Rule:  Administrative Simplification:  Adoption of a Standard for a Unique Health Plan Identifier; Addition to the National Provider Identifier Requirements; and a Change to the Compliance Date for the International Classification of Diseases, 10th Edition (ICD-10-CM and ICD-10-PCS) Medical Data Code Sets.  The effective date of the Rule is November 5, 2012.  Prior to publication, the Final Rule may be examined at or downloaded from the Office of the Federal Register’s Electronic Public Inspection Desk. Here…

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5010/D.0 Effective Date Tuesday, March 17, 2009; Compliance Date January 1, 2012

The version modification to the HIPAA Administrative Simplification transaction standards becomes effective Tuesday, March 17, 2009. Here are several critical things to know, drawn directly from the final rule published in the Federal Register on January 16, 2009. The final rule is available for download on the HIPAA.com site. Effective Date: The effective date [March 17, 2009] is the date that the policies set forth in this final rule take effect, and new policies are considered to be officially adopted. [74 Federal Register 3302] Compliance Date: On January 1, 2012, all covered entities will have reached Level 2 compliance, and must be fully compliant in using Versions 5010 and D.0…

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One Week from Today: 5010/D.0 Final Rule Effective Date

They’re coming: the Ides of March (the 14th); NCAA Basketball Tournament Announcement (the 15th); St. Patrick’s Day (the 17th); and 5010/D.0 Final Rule Effective Date (the 17th). If you are a covered entity, Level 1 testing begins Tuesday, March 17, 2009. Here are five things you need to do to start. Conduct a Gap Analysis. What do I need to do to become compliant on January 1, 2012? That date sounds far off, but it will be here before you know it. Unlike previous transaction contingency periods for covered entities and their trading partners, HHS has indicated that there will be no tolerance for those not ready. Read the final…

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CMS Confirms 5010 and ICD-10 Rules’ Effective Dates

In notification to the U.S. House and Senate on Thursday, March 5, 2009, Don Johnson, Acting Director, Office of Legislation of the Centers for Medicare & Medicaid Services (CMS), notified the Congress that “[i]n accordance with the White House Chief of Staff’s memorandum of January 20, 2009 entitled ‘Regulatory Review,’ a determination has been made that the effective date will not be extended and the comment period will not be reopened for either of these rules.” The effective date for each of the rules is March 17, 2009. The memorandum CMS sent to Congress follows. Beginning next Monday, March 9, HIPAA.com will have a posting daily through March 17, 2009,…

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Is Your Covered Entity Preparing for 5010/D.0 Testing? Part 2: Level 2 Testing

On March 17, 2009, the Final Rules for Modifications to the Health Insurance Portability and Accountability Act (HIPAA) become effective. HIPAA.com has available for download the final rules for 5010/D.0 as published in the Federal Register on January 16, 2009 (pp.3295-3328). The effective date is “the date that the policies set forth in this final rule take effect, and new policies are considered to be officially adopted.” [p.3302]. All covered entities are to be in compliance with 5010/D.0 on January 1, 2012. Testing can occur “from the date of the final rule until the compliance date for Versions 5010 and D.0.” [p. 3306] The Final Rules outline two levels of…

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Is Your Covered Entity Preparing for 5010/D.0 Testing? Part 1: Level 1 Testing

On March 17, 2009, the Final Rules for Modifications to the Health Insurance Portability and Accountability Act (HIPAA) become effective. HIPAA.com has available for download the final rules for 5010/D.0 as published in the Federal Register on January 16, 2009 (pp.3295-3328). The effective date is “the date that the policies set forth in this final rule take effect, and new policies are considered to be officially adopted.” [p.3302]. All covered entities are to be in compliance with 5010/D.0 on January 1, 2012. Testing can occur “from the date of the final rule until the compliance date for Versions 5010 and D.0.” [p. 3306] The Final Rules outline two levels of…

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Effective Dates for Modified HIPAA Administrative Simplification Transaction and Code Set Rules Coming in March

In less than three weeks, HIPAA Version 5010/D.0 transaction and ICD-10 code set rules become effective, and the clock starts running on testing in preparation for compliance several years hence. Next Monday, March 2, 2009, HIPAA.com will outline Level 1 testing requirements and opportunities for the 5010/D.0 transaction rule, and on Tuesday, March 3, 2009, outline testing requirements for ICD-10. Sign up for HIPAA.com email reminders for these and other HIPAA Administrative Simplification standards postings, as well as postings relating to the new Health Information Technology for Economic and Clinical Health Act and Medicare and Medicaid Health Information Technology (“HITECH Act”) provisions of the American Recovery and Reinvestment Act (“ARRA”)…

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Why ICD-10?

There were four main reasons that the federal government moved to ICD-10 as a code set standard: (1) ICD-9 dates to 1979 and its functionality has been “exhausted” and does not reflect “new and changing medical advancements”; (2) Parts of the ICD-9-CM were full, which required putting codes in “topically unrelated chapters,” burdensome for healthcare providers in a move toward more efficiency; (3) Insufficient detail opportunities: “[I]n an age of electronic health records, it does not make sense to use a coding system that lacks specificity and does not lend itself well to updates…Emerging health care technologies, new and advanced terminologies, and the need for interoperability amid the increase in…

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Classification Coding Systems

ICD-10 diagnosis and procedure codes are “classification coding systems” useful for conducting administrative transactions. SNOMED-CT® (Systematized Nomenclature of Medicine–Clinical Terms) is a “clinically complex terminology standard” designed for the primary documentation of clinical care that will enhance interoperability with electronic health record (EHR) systems. According to the preamble of the proposed ICD-10 rule published on August 22, 2008, “The benefits of using SNOMED-CT® increase if it is linked to a classification system such as ICD-10-CM and ICD-10-PCS for the purpose of generating health information that is necessary for statistical analysis and reimbursement. The use of both SNOMED-CT® and ICD-10-CM and ICD-10-PCS brings value to the development of interoperable electronic health…

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Migrating to ICD-10

Under the final ICD-10 rule, all healthcare providers will utilize ICD-10-CM to code diagnoses beginning October 1, 2013. For procedure coding under the final ICD-10 rule, physicians and all healthcare providers other than inpatient hospitals will continue to use the current procedure coding standard: Current Procedural Terminology, 4th Edition (CPT-4) and the Healthcare Common Procedure Coding System (HCPCS). Inpatient hospital services procedures will be coded using ICD-10-PCS codes, which provide facility related procedure codes suitable to inpatient environments.